What Is Bladder Cancer?
The bladder is the hollow organ in the lower abdomen that stores urine before it is passed out of the body during urination. Cancer occurs when bladder cells lose their ability to form normally and instead develop too quickly and too irregularly. Most bladder cancers form in the inside lining of the bladder, usually looking like a very small mushroom initially. In some cases, the cancer spreads into the surrounding muscles. Men are more commonly affected than women, and it usually occurs after the age of 55 although it can occasionally develop in younger people.
What Causes Bladder Cancer?
The main risk factor is smoking - cigarette smokers develop bladder cancer nearly three times more often than non-smokers. Workers in certain occupations are also more at risk - these include the petroleum, chemical and leather industries - as well as exposure to aromatic amines in rubber and dye industries. In Africa and the Middle East, urinary tract infection with Bilharzia (Schistosomiasis) may predispose to bladder cancer as well.
Occupations at risk due to exposure to certain chemicals and substances include;
• Rubber, leather and textile workers
• Truck drivers
• Petroleum industry workers
Three main types of cancer affect the bladder. They are named for the type of cell that becomes cancerous:
• Transitional cell (urothelial) carcinoma - more than 90% of bladder cancers
• Squamous cell carcinoma - about 4% of bladder cancers
• Adenocarcinoma - about 1%-2% of bladder cancers
What Are The Signs And Symptoms Of Bladder Cancer?
The usual sign is blood in the urine. This may be very faint or deep red depending on the amount of blood involved and is usually painless. There may be a desire to pass urine more frequently than usual, and occasionally a burning discomfort on urination.
Will I Have Any Tests Or Investigations?
If you see blood in your urine it is very important that you consult your doctor, who will organise some tests. After taking a history and performing a detailed physical examination, the following will be arranged;
• Examination of the urine for infection, stones and cancer cells.
• Routine blood tests, including a full blood count and kidney tests.
• An X-ray called an IVP - an intravenous pyelogram - where a dye is injected into the body and the kidneys outlined on simple X-rays taken afterwards.
• A specialist will look into the bladder with a thin fibreoptic telescope, passed through the urethra, and which allows a clear view of the inside of the bladder. At the same time, samples of tissue can be taken - called biopsies - which can then be analysed under a microscope for any cancer cells.
• If a cancer is present, a chest X-ray or bone scan may be taken to check if there has been any spread to the rest of the body.
The Staging Of The Bladder Cancer
The stage of a cancer tells the doctor how big the cancer is and whether it has spread. The tests and scans you have when diagnosing your cancer give some information about the stage. It is important because treatment is often decided according to the stage of a cancer.
The most common is the TNM staging system and is used for all cancers. TNM stands for tumour, node, metastasis. So this staging system takes into account
• How deeply the tumour has grown into the bladder (T)
• Whether there is cancer in the lymph nodes (N)
• Whether the cancer has spread to any other part of the body (M)
The TNM Stages Of Bladder Cancer
The T part of TNM tells you how far into the bladder the cancer cells have grown. Doctors find the T stage by a combination of looking at the grade of the cancer cells after a biopsy, examination of the bladder under anaesthetic, and a CT scan or MRI scan.
Stage CIS (also called Tis) - very early, high grade, cancer cells are only in the innermost layer of the bladder lining
Stage Ta - the cancer is just in the innermost layer of the bladder lining
Stage T1 - the cancer has started to grow into the connective tissue beneath the bladder lining
Stage T2 - the cancer has grown through the connective tissue into the muscle
Stage T2a - the cancer has grown into the superficial muscle
Stage T2b - the cancer has grown into the deeper muscle
Stage T3 - the cancer has grown through the muscle into the fat layer
Stage T3a - the cancer in the fat layer can only be seen under a microscope (microscopic invasion)
Stage T3b - the cancer in the fat layer can be seen on tests, or felt by your doctor during an examination under anaesthetic (macroscopic invasion)
Stage T4 - the cancer has spread outside the bladder
Stage T4a - the cancer has spread to the prostate, womb (uterus) or vagina
Stage T4b - the cancer has spread to the wall of the pelvis or abdomen
What Treatment Will I Need?
This depends on a number of factors such as the age and general state of health of the patient, how quickly the cancer is growing and whether more than one is present, and whether it has spread outside the bladder to other organs. A specialist will 'stage' the cancer to assess just how advanced it is by doing the above tests and sometimes a CT (computerised tomography) scan.
Early tumours can be removed at the time of cystoscopy by a procedure called a transurethral resection the bladder tumour (TURBT). If a number of tumours are present, this may be followed by drug treatment where a solution of anticancer drugs (such as cillus Calmette-Guérin, BCG) is put directly into the bladder.
Larger tumours that cannot be removed by a cystoscope are sometimes treated with radiotherapy - such X-rays to destroy the ability of cancer cells to divide and multiply.
If most of the bladder is affected, or the tumour has grown into the bladder wall, the bladder itself may be removed surgically - called a radical cystectomy.
For wider spread of the cancer to the rest of the body, chemotherapy treatment can be used where anti-cancer drugs are injected or given as tablets over a period of weeks and months. The standard pattern is of a period of treatment followed by a rest period for some weeks and this pattern is repeated a number of times.
The outlook for patients with early bladder cancer is very favourable, and even more advanced bladder cancer is becoming more readily treatable as treatments continue to improve. As each patient is different, your specialist will be able to tell you what you may expect with your bladder cancer and its treatment. Bladder cancer tends to come back, so regular check-ups are important.
Can I Do Anything To Help Myself?
Stopping smoking is vital, as is not being reluctant to ask your doctor about any fears or concerns you may have. Regular follow-ups after treatment are very important - often for several years - since bladder cancers can recur a long time after being initially treated.
Tell Your Doctor
1. Have you noticed any blood in your urine?
2. Do you smoke?
3. Do you work with chemicals or dyes?
4. Do you have to pass urine more frequently than normal?
5. Does your urine sting or burn when you urinate?
Ask Your Doctor
1. What are the side effects of any treatment I may need?
2. Will surgery affect my sex life?
3. Will I need a bag to collect my urine if my bladder is removed?
4. How long will I need to be followed up for in my case?
5. Are my children more at risk of bladder cancer?
Cancer Research UK
Telephone: 0808 800 4040
Address: PO Box 935, Harrow, Middlesex, HA1 3YJ
Telephone: 0845 608 4455